Arch Hand Microsurg.  2021 Dec;26(4):309-314. 10.12790/ahm.20.0064.

Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

• Baek S
• Kim S
• Shin MH
• Kim TM
• Lee SJ
• An SJ
• Kim SH
• Kwon YH

• KMID: 2522631
• DOI: http://doi.org/10.12790/ahm.20.0064

Abstract

Purpose
We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.
Methods
Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.
Results
NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.
Conclusion
Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

Keyword

Phrenic nerve; Brachial plexus; Trigger points; Thoracic outlet syndrome; Injections

Figure

• 

  Fig. 1. Three criteria for diagnosing thoracic outlet syndrome.

• 

  Fig. 2. Demonstration of the surface anatomy.

• 

  Fig. 3. Schematic of scalene injection site. M, muscle; Ext., external; V, vein; SCM, sternocleidomastoid.

Reference

1. Kim SH, Baek S, Kwon YH. Prevalence and clinical characteristics of neurogenic thoracic outlet syndrome in specific industrial field. J Korean Soc Surg Hand. 2016; 21:113–21.

2. Kwon YH, Chung H. Thoracic outlet syndrome. J Korean Med Assoc. 2017; 60:963–70.

3. Sanders RJ, Haug CE. Thoracic outlet syndrome: a common sequela of neck injuries. Philadelphia: Lippincott;1991.

4. Roos DB. The place for scalenectomy and first-rib resection in thoracic outlet syndrome. Surgery. 1982; 92:1077–85.

5. Urschel HC Jr, Razzuk MA. Neurovascular compression in the thoracic outlet: changing management over 50 years. Ann Surg. 1998; 228:609–17.

6. Yudoyono F, Senjaya F, Yuniarti M, Gunawan V, Arifin MZ, Faried A. First single centre experiece in thoracic outlet syndrome. JSM Neurosurg Spine. 2015; 3:1055.

7. Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery. 2004; 55:897–903.

8. Lee GW, Kwon YH, Jeong JH, Kim JW. The efficacy of scalene injection in thoracic outlet syndrome. J Korean Neurosurg Soc. 2011; 50:36–9.

9. Lum YW, Brooke BS, Likes K, et al. Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome. J Vasc Surg. 2012; 55:1370–5.

10. Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci. 1999; 4:66–9.

11. Brantigan CO, Roos DB. Diagnosing thoracic outlet syndrome. Hand Clin. 2004; 20:27–36.

12. Lundborg G. Richard P. Bunge memorial lecture: nerve injury and repair: a challenge to the plastic brain. J Peripher Nerv Syst. 2003; 8:209–26.

13. Sanders RJ, Monsour JW, Gerber WF, Adams WR, Thompson N. Scalenectomy versus first rib resection for treatment of the thoracic outlet syndrome. Surgery. 1979; 85:109–21.

14. Gilliatt RW. Thoracic outlet syndrome. Br Med J (Clin Res Ed). 1983; 287:764.

15. Jang JH, Lee GW, Kwon YH. Thoracic outlet syndrome caused by automobile accident. J Korean Soc Surg Hand. 2009; 14:230–3.

16. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973; 2:359–62.